The Fix

Friday, December 18, 2015 - 04:49 PM

This episode we take a sober look at the throbbing, aching, craving desire states that return people (again and again) to the object of their addiction … and the pills that just might set them free.

Reporter Amy O’Leary was fed up with her ex-boyfriend’s hard-drinking, when she discovered a French doctor’s memoir titled The End of My Addiction. The fix that he proposed seemed too good to be true. But her phone call with the doctor left her, and us, even more intrigued. Could this malady – so often seen as moral and spiritual - really be beaten back with a pill?

We talk to addiction researcher Dr. Anna Rose Childress, addiction psychologist Dr. Mark Willenbring, journalist Gabrielle Glaser, The National Institute of Health’s Dr. Nora Volkow, and scores of people dealing with substance abuse as we try to figure out whether we're in the midst of a sea change in how we think about addiction.

Produced by Andy Mills with Simon Adler

If you are someone looking for help with a substance abuse problem and want to find health care services in your area, check out this map from the Substance Abuse and Mental Health Administration.

For more on Dr. Mark Willenbring and the Alltyr Clinic visit their website.

Alcoholism is a layered beast. It is sneaky and it is powerful. Medication can help, sure. But it's very difficult, as a 41 year old sober woman (almost 7 years) to believe that after the craving is gone, the desire will also stay away. It took a good 2-3 years for the desire to leave me. I did not crave any longer (with no meds) but I sure did struggle with my alcoholic mind.

The discussion about wanting to be a normal drinker and then moderating the drinking after taking the meds, is yet another attempt to take an easier way. For most, in time, we decide we maybe are normal drinkers. Our addictive mind tells us we're fine. So we go back. Unless we are maintaining our whole selves. At least that's the experience I've had. When I let my destructive ruminating mind get the best of me, I'm in danger. That can happen with or without a pill.

I've done a lot of writing about my journey, if it will help anyone here. http://extraordinary-ordinary.net/2010/06/03/the-way-home/ I'm sending you peace and hoping the freedom I've found will find its way to you.

I'm admittedly bothered by the other side of the coin (so to speak) not being shared much in this episode. There is no way to measure the success rate of AA, and that was mentioned, but the low numbers of success (erroneous or not) are what stick with people. What we need are stories from those of us who go to meetings and know for certain that it is not something that anyone can describe. When we "just keep comin' back" we find out, sooner or later, why it works. Let's not tell the story about the unhealthy people who send emails saying "I hope your kids get killed by a drunk driver" I have not met one person in the community of AA who would say that. There are dysfunctional people in all places, but if we could focus on the miracles that are occurring, it would help more people. Turning them off of anything that could possibly help is a disservice.

Try the medication, I won't tell you it's crazy. I'm just here to say that many things can work together for good and the foundation of "the program" is an openness. Acceptance. Surrender. Believing that it isn't your job to control the decisions of others, including how they get sober. What matters is not if a pill is the answer, or treatment is the answer, or AA is the answer. It is about what the person getting help believes and perceives. If you are open, something will work for you. The trouble with addiction is that we get desperate, say we want help, but there is still a part of us that just can't let go, can't imagine life without the drug or drink, we get scared...we quickly give up. The success rate hinges on that.

I don't doubt that these pills work but taking a drug to counteract another drug is never good, especially when it comes to the central nervous system! Instead of trying to supress it we should be bringing it back to its normal state. I was addicted to alcohol and recreational drugs (including cocaine) until I found Tanscendental Meditation. It took my mind and body a week to settle through meditation but the results were immediate. Straight away the feeling of anxiety that had been with me all my life was gone and the need to supress it with drink and drugs also disapearred. The feeling of inner peace I felt gave me a greater feeling than drink or drugs ever did and since then I have been able to control my addictions. Also reading Gabour Maté's books have given me a great insight into the cause of addiction. I think we should be looking at the root causes of addiction instead of taking more pills (which always have side affects) and try and put our bodies and minds back in balance.

Let's not dismiss nor embrace "will-power" and let's not embrace nor dismiss "science," instead let's dig beyond and find the microscope that's pointing in a different direction. Of course it is an issue of "will-power" but that doesn't mean a victim of heroin or crack or booze has no will or power. We do,it's just pointed in the wrong direction, such as for survival purposes.The measurements of science have validity but then the next question is: So WHAT? How is that helpful? Are you saying that so that people stop bullying victims and themselves as victims? Because there's an obvious way to stop the bullying, which is to re-direct the will-power. Inasmuch, the science follows suit. There is a reason for the "will-power's" re-direction: a real life reason, and it's not the "science," a "biological" root. No, the root is beyond. Other things run in families: abuse, sexual abuse, emotional abuse, generational trauma, mental suffering, attachment issues, family dysfunction. The list is long. A reason: Someone has stolen our will and our power and pointed it in their direction. We were all traumatised. We lost our vision, we couldn't see. We went along with it, we knew no better. The biggest factor of getting well is there being ONE PERSON, an outsider, to loosen up our spinal column, help us practice the flexibility we once had, and point us in a different direction and let us decide where to look out and find the light we connect with and want to walk towards. It takes one person. Not a slew of doctors, scientists, pharmacists. Perhaps we should contact the philosphers, the theologians, spiritualists, musicians, artists, dancers, sociologists, ecologists. This is not a terminal "disease." If someone reaches out for help for long enough, someone will grab on. Wake up and reach out for something you don't know what but you know is there. Keep reaching.Wake up and look around, into the darkness, you'll find a little tiny spark of light, barely flickering. Reach for it, grab hold, and nurture it, and beyond that, help it remember how to nurture itself.

The case of Dr Olivier Ameisen it's essential in the history of baclofen but represents just the beginning and a lot of other things happened after and thanks to his "case report". Not so funny to publish private conversations that don't have nothing to do with the baclofen therapy and with the really great discovery made by Dr Ameisen.

The other case report of Ed Coleman mentioned by Dr. Childress dates 2000 (or earlier) and here you can read the news in NYT: http://www.nytimes.com/learning/teachers/featured_articles/20001114tuesday.htmlAfter that, Dr Childress made other studies and this is the most recent one: http://www.uphs.upenn.edu/news/News_Releases/2014/04/childress/Why not a single word about it? Or about the registered Clinical Trial where Dr Childress is primary investigator on some Baclofen Extended Release! (still not available) for cocaine dependence?https://clinicaltrials.gov/ct2/show/NCT02003664

There are many studies that shows the efficacy of baclofen, not only for alcoholism but also for other addictions.In France, on March 2014, has already received a "Temporary Recommendation of Use" and is actually prescribed to over 100.000 alcoholic patients with great results. Also other European countries are actually following the French experience.Just few months ago a new Clinical Trial from Germany with high-dose baclofen proved its safety and efficacy as treatment for alcoholism: http://www.sciencedirect.com/science/article/pii/S0924977X15001029Other Clinical Trials are on the way and results will be published soon.

About all other medications (naltrexone, acamprosate, gabapentin, topiramate) the information given is really poor and not at all scientific based (naltrexone does not have at all a 78% of success rate and "The Sinclair Method" has never been tested in Randomized Clinical Trials). The medical community certainly knows really well this medications but they are underused mainly because their efficacy is really poor and unfortunately there are still too many doctors that consider the "AA abstinence" the only solution.

Hopefully we're on the web... and you can simply type "baclofen alcoholism" in any search engine and get updated with a lot more of information! ;)

I'm another 12 stepper but I'm not here to rant against a multi-pronged approach to treatment. I think it's great to have options. The 12 steps don't work for everyone. I think combining approaches is great as well, and any 12 stepper who wants to tell someone taking suboxone/baclofen/whatever to help deal with cravings that they "aren't sober" should take a frigging seat and stop being a jerk.

At the end of this episode, talking about the emptiness of sobriety-- that is what the 12 steps are really good for. If taking a medication can help someone stop using, that's awesome, I am all for it. But please consider some form of recovery support group to help you find out who you are without the drugs/booze, and help you fix your life. Glad to hear that Billy came to that conclusion, too.

HOWEVER, I am mainly here to give a warning about baclofen. Baclofen is actually one of the few drugs that has a withdrawal syndrome which can be potentially fatal. From here:

I actually watched this happen to my roommate. Suddenly stopping baclofen sent them into a manic/psychotic episode which lasted for days until we finally had to call the cops to take them to the psych ward. It was horrible. Thank god they got medical attention because they could have literally died.

So: BE REALLY CAREFUL WITH BACLOFEN. Do not use it without medical supervision. I am really concerned about the idea of people who have poor habits around the use of drugs trying to self-medicate with this on their own. If it works for you, that's fantastic, but DON'T STOP IT SUDDENLY.

The program clarifies the complexity of who we are as human beings. Not mentioned was the results of sobriety in human beings. Whether their lives are filled with more material objects we measure success by or how much personal gain they accumulate is preposterous. I've found regardless of how a person reaches sobriety that the longer they stay sober they become more loving, tolerant, understanding people. This is the goal. To maximize our greatest potential Love. All the rest is BS. Whatever it takes to arrive there should be the objective. The idea of "just not using alcahol or drugs" is narrow minded.

Telling addicts that have struggled to rebuild their lives, against all odds,that maybe a chemical solution might have saved them from the most deeply scaring experience of their lives, obviously engenders angry outbursts born of deep psysiological and emotional pain;that narrative deprives them of the meaning the worked so hard to make out of their own personal suffering. As creatures painfully aware of their challebges, limitations and losses, finely attuned to the suffering of others, yet so rarly capabale of exerting and real influence over the course of their lifetimes (i.e., the 4 noble truths), human beings must make meaning to survive. They must build a narrative, and repeat it as long as it takes, until they are at least marginally numbed to their seemingly senseless suffering that they are often genuinely powerless to change.

Treating addicts with medication is clearly effective, but it's also simultaneously disempowering- it trivializes the grand narrative used by AA and many others that claim there some higher cause or master plan that justify their suffering. Such profound suffering is only bearable when one can delicately weave meaning through its devestating power, creating a lifeline to the present.

Just listened to this show as I work backward through the archive. My 28-year-old son (sober 25 months now) was on his way to jail/death with alcohol and heroin abuse. He had been through deteox/rehab 4 times over 10 years. After his last detox, he was given Vivitrol and returned to AA. The Vivitrol was very helpful in eliminating the physical cravings for alcolol and heroin. He stayed on it for 6 months. Surprisingly, when you ask him what has kept him sober now for 25 months, his answer will be AA, not Vivitrol. There are true, profound benefits from this program. I was troubled by the start of this podcast that sounded like it was dismissing AA due to concerns about the God element. It also seemed to characterize it as an old approach as opposed to a modern "evidence-based" approach with meds. Working together, they saved my son's life. (Note: Vivitrol costs $1000/monthly shot - so it may not be an option for many.)

I guess I'm just old fashioned. I crashed and burned and ended up in A.A. back in Aug. 1981. In the past 34 yrs I've heard every cockamamie idea on how to "kick" the habit by taking some pill or hypnosis or lobotomy. The pathetic reality is, we live in a world that is self deceived with the notion that it is possible to negotiate pain and/or accountability by simply taking a pill. The premise of this delusion is not only foolish, but deadly, as I have seen 3 decades of people die as a result of buying into these lies.

We humans are funny creatures. We avoid pain at any cost. Unfortunately, life IS pain. The very idea of "if I just take this pill, I can achieve permanent sobriety!" is as ludicrous as having a nuclear warhead as a coffee table in your living room. It will only end up killing scores of people, and no one will be held accountable for it, much less these half-wits with this podcast. (so-called)

In summary, you want sobriety? You have to earn it. It's the hardest work you will probably do in your life, and it's worth it. Get off your rear-end and get to A.A., get a sponsor and fall on your knees and pray.

And when you hear this kind of 'pill-cure' garbage, run for your life. Want to know what it takes to get sober? Give a listen:https://www.youtube.com/watch?v=Q3g-L7B5tzI&feature=youtu.be

Mark

ps. Someone posted this on Waste Book. I've since been blocked and comments deleted for my observations I posted in response to these idiots.I suppose she will have to learn the hard way. pity.

Thank you for airing this episode-- it was very interesting to hear the perspective of people struggling with these life long addictions. As a medical student some comments popped out at me. There was a comment along the lines of how very few medical schools have courses for students in addiction. Do we have a whole course in addiction? No. Just like we don't have a course in diabetes or heart disease, but we study these topics extensively in the context of our courses in anatomy, physiology, pathology, etc. Additionally, during the first two years of medical school we take a course devoted to behavioral sciences-- a good majority of the time is spent talking about drugs and alcohol. Additional we have a required rotation in psychiatry during our third year which involves working long shifts at inpatient and outpatient centers, where many of the residents are suffering similar stories like the one shared in this podcast. I also think that it's important to note that these drugs that are being brought up, are not benign medications. Some of them work by producing an ill effect on the user. So yes, while one magic pill does seem like a glorious answer, a lot of behavioral modifications are needed to overcome addiction.

Groups like AA can be useful for people in early recovery because often addicted and alcoholic people have damaged or destroyed their relationships with friends and families. Showing up to meetings gives people who may be out of a job or just looking to fill the time they used to spend drinking with somewhere to go and talk with people who are also trying to stay clean and sober, and allow them to start socializing while sober again. They also are a good resource get phone numbers of other addicts, calling someone when you are feeling like relapsing can help you avoid a relapse. There are completely irreligious support groups similar to AA like Lifering for people who don't feel comfortable with the God aspect of AA, NA and others.

That being said I think ultimately medical treatment should supersede these 12 step groups as a primary and first stop for people wanting to treat their addictions. Support groups are definitely great resources that I feel will always exist in one form or another, but I tried those personally I found them ineffective.

I've been on Suboxone, a partial-agonist opiate replacement, for nine years. In that time I've completely rebuilt my life. I am a working professional in middle of building a career, I've got great relationships with my family and friends, it keeps my blood pressure low without any other medication, and has actually moderated my depression. It has really been a miracle. I did outpatient treatment, inpatient treatment, I did AA for years, 90 in 90, worked the steps with a sponsor, but always relapsed. It was only after I started on the suboxone that I have not relapsed. I would not have half the life I have today otherwise. Frankly I may likely have been in jail or worse had I not been prescribed this medication.

As a partial-agonist it does not make me high and does not alter my mood or thought process. Because it binds strongly with the opiate receptors in the body if I were to take a full agonist opiate, which I did try once in the first months that I started taking suboxone, they can't displace the opiates and have no effect. It contains a full antagonist called naloxone to prevent intravenous abuse. It is all in all a great medication and has been a life saver for a lot of people.

There are downsides. I remain physically dependent on this medication. If for some reason I was unable to procure a refill I would go into withdrawal, a state that would definitely put me in danger of relapsing. If I didn't have insurance the medication would be prohibitively expensive. For me those are insignificant trade offs to have my life back. I do go to a support group once or twice a month but it isn't 12 step, it is a medical support group headed by a licensed professional.

Whoa, I find it funny that the only people who had a problem with this episode of Radiolab are the people who are members of AA. It wasn't a criticism of your club! It was just some data they found and that data is as accurate and credible as any data can be. The point was that the drop out rates for AA are HIGH, who cares how high? And they even qualified that statement by saying that that statistic alone is not evidence that the folks who don't show up are using again. These folks could be doing just fine or may have found another form of counsel for their addiction. My point is that this show was about so much more and reading all these comments from disgruntled folks makes me feel like they missed the point.

I am addicted to oxycodone because I have chronic pain and I cannot take alternatives (Tylenol, Advil because I only have one kidney). The ..... Xones that you mentioned are very well known in the addict community but Medicaid does not pay for it. With Medicaid it is almost impossible to find a pain management specialist and there is a year long waiting list for the 1 or 2 available in Sonoma County for instance. I was prescribed Gabapentine but it had horrible side effects and was definitely mind altering to me to a far greater extent than oxycodone . I do not take opiates for the high because I don't get high on the dosage I take but this does not mean I am not physically addicted. If, by some miracle, my pain disappeared it would be impossible for me to quit alone anyway because of the terrible withdrawal symptoms. I have lost all taste for alcohol however. BTW Cocaine does not cause physical addiction.

I am wondering if there have been any tests where people were given a placebo and non-alcoholic beer and tested if people have had the same effect of being "turned off" to getting drunk. This is an amazing story and really hits home because many of my family members are alcoholics. I hate that it ruins so many of us and that addiction isn't taken seriously.

This was a great podcast but it was a major oversight and missed opportunity to omit any discussion of The Sinclair Method (TSM) for the use of Naltrexone in the medical treatment of alcoholism. Ocean and Tarama M. and others in this thread have already introduced TSM. It is because the TSM protocol requires taking naltrexone while continuing active drinking by the alcoholic that it is so antithetical to the incumbent abstinence-only 12 step approach. There are other protocols for using Naltrexone, such as Vivitrol, a 30 day extended release injection, that are more widely prescribed but are much less effective. This controversy should have been explored in this episode. May Radiolab can "Fix" this in a future "short". In the meantime, I encourage all those who have used The Sinclair Method (successful or not) to continue to share their experience as widely as possible, to help educate the public and the medical profession. Eventually I hope there will be enough practitioners of TSM that they can have their own network of active support groups around the world.

I found this episode very interesting...not because of the idea of a medication that can turn off addiction, but more for the peoples reactions. It saddens me that as a society the stigma we still place on people with addiction. At one point we viewed people with depression as being lazy, and not until we recognized it as a disease and found medications that helped, did we truly understand and help those people and our society. Addiction is no different. The brain is an organ and is not perfect. Not everybody's brain will function the same way. So the solution is not one way only.

There are many levels of addictions. There are some individuals that are purely addicted to the drug just b/c the drug is addictive. Getting them off the drug will work. Others use it as a coping skill, detoxing them and teaching them how to deal with the world the right way and giving them the support they need works for them.

For others, their brains are not right, the drug fixes what ever isnt working right. They are the ones that have that constant nagging in their mind that they need that drug. All the brain knows is that it is missing something so it makes you crave something, and the easiest way for your body to get what it needs is to make you want something that either tastes good or makes you feel good (otherwise you wouldnt take it)

Another way to look at it is to imagine a telemarketer calling constantly, most people would turn the ringer off, unplug the phone or change their number. These people cant, the phone is out of reach. So we expect those people to ignore the call plus we also expect them to learn new coping skills, all the time the phone is ringing. Yet we expect them to ignore the phone call, could you? Maybe for a little bit, but after a while you would resort to what ever means possible to turn it off. That is where medication comes in. Yes they are addictive, but many do not have the "high" effects that the drug of choice has. But we shouldnt stop there, swapping one medication for another wont truly help everyone either.

We need to adopt a multi-modal approach to addiction. Get people of the nasty drugs and alcohol, get them on a medication that takes away that nagging. Make them feel normal. Some may have underlying other mental problems that have gone diagnosed. Address them and medicate them properly. Then AA comes in, teach them, support them, educate them. When a person is feeling normal they are more likely to learn new things. We may also need to change peoples living situations...so do it. The moment we view it as a biological disease and use EVERYTHING in our arsenal to treat it, not just one or the other, will be the moment you will start to see recovery rates sky rocket. The sad thing is b/c it is a disease you will have some people who need to be on medication for life.... but if a diabetic can do it, so can they, esp if they have experienced rock bottom and we give them the tools they need to be successful.

I'm on naprexone and bupropion. I used to smoke and drink heavily. Well, it's been just over four months. Zero smokes. And infrequent drinking. Pretty much it helps me pause, think do I really want a drink, and usually end up not bothering. I'm in my 40s. If I had found this in my early 20s wow, I would have accomplished so much more in my life.

I haven't even finished this episode. Luckily my boyfriend came home before my blood could really start boiling over. I am a huge fan on RadioLab but this episode was so poorly researched and a complete misrepresentation of not only AA but addiction as a whole. I don't even know where to start.For one, muscle relaxants are an addictive substance in and of themselves and the last thing addicts need is a new substance to become addicted to.Next, the mention of the man who was addicted to coke and prescribed this drug seems like an obvious example of the addictive mind. He began trying different doses of the medication he was prescribed because obviously he knows better than the doctors. Then, when the medication did make his symptoms better and you claimed his cravings were alleviated because he couldn't feel the high from the coke, he did just the opposite of what a person without the cravings would do-cut his medication's dose in half so that he would be able to experience the high from the coke. This leads to the point that a person would really have to want to quit to be trusted to continue to take the medicine. While most non addicts think that all addicts would want to quit, this is far from the truth. Addicts love their drug of choice. It is a part of them, it makes them feel whole in a way nothing else can. In the worst of my drinking I was prescribed an antibiotic which I was told I could not drink while I took or I would get violently ill. So what happened? Those pills sat in my cupboard untouched until the day I got sober.So this leads in to the big point. Addiction is not a disease solely of the body. The reason AA is so incredible is that an addict can go to any meeting and if they are being truly honest with themselves, they will hear parts of their story coming out of every person's mouth. Because most addicts begin using for nearly the same reasons and their drug of choice, no matter which it is, makes them feel the same way. Addicts feel as though the are different from everyone else, but when they are using they finally feel like they belong in the world. No drug can make that feeling go away. It takes therapy, looking in to yourself, and making changes in your life. Having been a member of AA for coming up on 3 years I can tell you, the success rate isn't great. But it is nowhere near the numbers you came up with. I have had friends die way too young, I have watched people go back out and destroy their lives again. But more importantly, I've watched people turn their lives around. I have turned my life around. Everyone wants an easy solution, but I don't believe there ever will be one. There is a big difference between a medication that makes you not feel the effects of a drug, and one that makes you not want it.There is a joke in the AA world that I think really sums up the ridiculousness of your claims here-If an alcoholic was offered a single pill that would cure his alcoholism completely, the alcoholic would want 2.

As they say, lies, damn lies, and statistics. The reality of ALL treatments today is that there is a very low success rate. Recovery is HARD. And until we stop treating addiction as a failing of morality, a purely behavioral issue, its going to continue to be an uphill battle.

I have some hope for clinical drugs to assist in this battle. If you can get someone disconnected from their cravings it gives them a fighting chance. Those first 30, 60, 90 days (or more) are brutal. It could help some people, but as Billy noted, its not the end of recovery because...

...for many of us, alcohol isn't just the problem, it's the solution. So that begs the question, what's our real problem? Here's where counseling, AA, or your group therapy du jour can and should continue to be a part of recovery. Call them defects of character, regrets, apologies, amends, or just plain How I Was an Asshole for 25 years. It needs to be dealt with.

One last note: Of course God is part of the AA literature. It was designed by old white guys in the 30's in middle America. Don't be so shocked and surprised. But it wasn't a part of my recovery. Its not a part of many people's recovery. But, as a global community with many different religions represented, it is a big part of many people's recovery. Probably mirrors the percentage of people who would identify themselves as religious, but that's just a guess.

baclofen is a GABA-B agonist. I'm a narcoleptic with cataplexy. I started baclofen 5 months ago and it made many of my symptoms stop. Odd thing is that narcoleptics don't tend to get addicted to things. We're missing the feedback mechanism. Go figure. Honestly the only medication that I've felt addicted to (jones for) is baclofen and xyrem (ghb).

I had to comment on this story. While it would be great to believe that one day simply taking a drug will eliminate one's addiction, there are other aspects to the addictive personality beyond using/medicating with the drug of choice. In AA these are described as Defects of Character and play an important role in the addiction and relapsing. These Defects of Character are addressed in the 12 step program, in which the recovering addict is given tools to correct their behavior and restore within themselves, a sense of value and integrity. When I listen to Billy, I hear all the familiar hallmarks of someone early in their recovery. The "negotiating" with the addiction. He says he was originally completely opposed to AA where later he returns to it and is working it alongside his drug treatment. This initial opposition is something that I relate to where the part of me that enjoys using does not want to enter into a situation where it could be eradicated. I love Gollum from the The Lord of the Rings. If ever there was a outward manifestation of the voice of my addiction, it would be Gollum. The conflict within him to have his "precious" and what he's willing to sacrifice in order to do so. We shouldn't assume that just because someone says they want help and enter into treatment, that there is some sort of 100% commitment to healing and that this contrary voice is no longer a threat. It is absolutely there, especially in someone just entering into recovery. And that conflict between wanting help and the super Pavlovian response to take that hit again shows up in, as AA puts it, Cunning, Baffling, and Powerful ways. So I hear that negotiating with Billy. Dismissing AA removes a big threat to his addiction. Then he can set up a way to continue to take this drug which allows him to drink 2 - 6 drinks every evening, which is an improvement, and good for him on that. But the idea that one still needs 2-6 drinks a day says that they are still addicted. I hope he sticks with it and finds true sobriety, that is 0 drinks a day, one day at a time, for the rest of his life. I've seen in people who society would have thought hopeless. In the meantime, here's to one day inventing a medical treatment that effectively snuffs that addictive impulse.

I love Radiolab but I am really dissapointed in this show. I am a member of Alcoholics Anonymous and we respectfully ask that people that attend AA be anonymous (it's part of our name). The man who attends AA, Billy, gives his whole name, and that may seem OK, because he said to. But what happens is that people hear this and think, oh, AA didn't work for this guy. And AA doesn't work for a lot of people (you said about 1% are successful). But it works for some people and I would hate for someone to not go that would have been successful. Also it doesn't help Billy, because he becomes a spokesperson for AA, and we don't have any leaders or people who personally represent us.http://www.aa.org/assets/en_US/p-47_understandinganonymity.pdfThanks

I found this really fascinating! I have been addicted to substances several times in my life, and have found ways to overcome the addictions. Currently my husband is a recovering addict, from opiate use.

I listened to the podcast last night and then directly after started reading a book called "Why Him? Why Her?" By Helen Fisher. Somebody I met randomly recommended this author to me, he said any of her books. When I went to the library this was the only one they had, and while I am already married I thought there might be a reason why I would find this book useful. In the book the doctor describes for main personality types that she uses as the psychology behind chemistry.com. It made me realize something about my relationship with my addict husband. Whenever he was actively using I didn't want anything to do with him in a romantic stance. I didn't understand why, I just felt like he was more of somebody that I felt the kind of affection with talking to the bus stop or something, rather than my husband. It's important to know that he wasn't always using in our relationship. He actually started just before our wedding this year. (Here I was thinking, we got married and then everything changed!)

I am beginning to understand something now. He also said like Billy (?) The guy who likes to drink, that whenever he uses he is the person that he wants to be. While it was discussed in the podcast about something being spiritually wrong with an addict, I think that is the problem. If you don't like who you are, but you like who you are while you are using - of course you will keep using! Maybe the solution is to spend more time with oneself. To learn to love oneself as they are. As I mentioned earlier I have been addicted to substances, but for the same reason. When I was addicted to alcohol I wanted to be more social, because I'm more introverted by nature. When I was addicted to opiates, I wanted to be more excepting of my circumstances, because I didn't like where I was and that I didn't have control over what was happening to me. (That's a whole complete story in it's own. I first tried opiates when a person who I trusted gave them to me unknowingly for a period of time. By the time I realized, I was already physically addicted and I didn't like what happened and my circumstances so I decided to keep using to numb the pain. I wanted to be more accepting, and was only able to kick the addiction when I realized that numbing myself was not the way to accept what happened to me .)

Now, back to my realization about my husband. When he was actively using all the time he was not the person who I fell in love with. His personality was completely different and probably falls into a different category according to the work of this doctor that I am reading about. Try as I can, and could, I could not bring myself to love him in the same way that I did before. I'm at the end of your character limit, email me if you want!

This is such a sad and fascinating look at something that effects so many. I really appreciated the evolutionary connection with reward seeking behavior having been such a positive thing in the past and how hard that is to have our environment shift so drastically that it makes those behaviors so detrimental. I particularly resonated with the idea that the love and relationship response gets high jacked during addiction. On the spectrum of such things I'm not a serious addict, but I have struggled with tobacco addiction on and off for over ten years. Even before hearing this I had noticed with some self-deprication that the times when I pick up smoking are times when I am either single and not feeling connected to a community or going through a hard time in a relationship. Though when these needs are met I can usually stop smoking until feelings of isolation come up again. How interesting for me to learn that those responses may be using the same neural circuits.

A lot of people complaining and disappointed at this episode because their personal experience is different. This episode did not say AA doesn't work. What it is saying is that the numbers prove that the percentage of people that it works for is very little. If it worked for you, good. You're that rare case. Now let these people find an alternative that works for those that need an alternative.

The story evolved to include a practitioner who elected to inject a person with Voltaren. The narrator went on to indicate that this , by the way, was a similar drug with similar properties to baclofen.

Voltaren (diclofenac) is a non steroidal anti-inflammatory drug used to treat joint inflammation (arthritis) with some analgesic properties . Baclofen is an antispasticity drug which works predominantly on nervous system (primarily at a spinal cord level).

It was indicated that voltaren is similar to baclofen in that both are "muscle relaxers" . Such is not the case. They are not similar in terms of formulation or mechanism of action.

First I love Radiolab and dont usually send in comments but this show hit home with me.I feel comments made on the show about AA were just wrong. I am a member of AA and it has greatly improved my life. AA works for the people who commit to it and while it does not work for everyone it does work for many. I was not and still am not a church going person but I do believe in a power greater than myself and this is all you need. What upsets me most is that people who could really benefit from AA maybe turned off by the comments made on your show and never get the help they need. I expected more from Radiolab in doing their homework before making the statements they did.

I've been sober for a number of years thank to AA. I'm not Christian nor do I subscribe to any form of monotheism or a man in the sky. This is just one of many wrongful portrayals of AA in The Fix. Do we have religious members? Yes. Do we have laid back, even atheist members as well? Yes. We are a large organization with diverse representation. I'd like to echo an earlier comment on the flaws in the research methodology of the studies cited here.

I was disappointed in the coverage on AA in this episode, it seemed nobody on the show had any practical experience with AA and the reporter seemed really misinformed. I always count on Radiolab to offer unbiased and well researched accounts of what they are reporting, but this episode just seemed sloppy and unprofessional.

Thank you for this episode! I attend a 12 step program for an eating disorder and I always appreciate learning more of the science that's going on surrounding addiction.

More personally, I appreciated the intimate and open conversation with the man struggling with alcoholism. One of my greatest struggles in recovery has been trying to figure out who I am when my life isn't consumed by the eating disorder. His story resonated with me and I'm grateful for the attention to the very human struggle of creating a new life after addiction.

Thank you for a thought-provoking episode. I wonder about early attachment style and its correlation with addiction, especially in light of some of the ideas shared at the end of the episode. If drugs hijack the reward centers of the brain, the same parts that help us fall in love, enjoy food, and help us survive (at least evolutionarily), perhaps we need to better understand those parts of the brain and why some of us fall prey to addiction and some don't. I'm wondering if a lack of secure attachment early on affects those areas of the brain and leaves us more vulnerable. In essence, we may "bond" with alcohol or drugs or other rewarding or comforting sources when those areas of the brain have not been shaped by a secure attachment. Our brains are so plastic at birth and in those early years and I have no doubt that our experiences or lack of experiences with reliable connection and bonding affect us greatly. We who battle addiction may not be the fittest of the fit -- we may be craving the kind of comfort and reward we never got elsewhere, even from loving parents who simply had their own issues and could not give us the security we needed.

My father is an alcoholic who was sober for twenty years--while his kids were in middle/high school. But when the kids were grown up he fell off the wagon. Drinking and smoking were crucial to his self-conception as a creative, independent individual. Not identifying as "dad" anymore, he fell back on that other sense of self. It wasn't till he got a new self-image--as a grandfather--that he could regain sobriety. The grandchildren that got my dad sober, also caused me to stop smoking, and made my husband stop getting black-out drunk. We identify as dad and mom now. But how will we prepare self-images for the future? Ideas of ourselves as creative, and open, that don't require returning to the addictions of our twenties?

I'm not an addict, but I'm married to one and this episode really touched a chord with me. I don't have first hand knowledge of addiction, but I've lived with the devastating effects it has had on my family. Having watched my husband struggle with the disease for 8 years now I'm convinced it is different for everyone. From his experiences though I don't think he could solely rely on a medication to help him. Back when it was first discovered he was using opiates he went on Suboxone. He didn't really believe he had a problem and took the drugs when he felt like it, talked to the psychiatrist he was assigned in order to get the medicine once a month and never attended meetings. He wasn't convinced he really had an addiction so within months he thought he was cured. It came back with a vengeance and about a year and a half later had lost his 6 figure job and was being investigated for writing prescriptions. At that point he feared losing everything so he did an experimental treatment of Naltrexone implants. he went to a 28 day rehab, came home and resumed life with some counseling, but no real recovery program or friends who shared similar experiences. Almost a year to the day he came home from rehab he had cut the implant out himself and was back in his addiction full force. Over the course of the next 5-6 years he has been in and out of rehabs totally forgoing any type of medicine believing that it was just replacing one drug for another and solely relying on AA to help him stay clean. He has relapsed time and time again even after having 17 months clean with just AA. About 9 months ago he started seeing a psychiatrist and is now taking some medications (I'm not sure what he takes) for anxiety and depression and still staying connected to the AA program. I've had my doubts about the drugs to stay off drugs, but I do think in some cases it is needed. What I've also observed is that there definitely is a spiritual or relational side that needs to be addressed if someone is going to take the medications. Having the support of AA or another group of people going through the same thing seems extremely important. Just like Billy described going off for the weekend because he didn't need it. If you have a support system and have a place to go where you can listen to people share similar experiences you have a foundation to sustain you when the voice inside says you can do it alone.

I was a little surprised that no mention was made of Ayahuasca or Iboga, which to date has been the most effective to cure addiction. Dr. Gabor Maté is probably the most well-known for using Ayahuasca to cure addiction.

I am skeptical of feeding addicts a magic pill like Baclofen which is a GABA antagonist and causes benzodiazapin like withdrawals which are fatal. Bupe, Suboxone and methadone are all WAY more addictive than heroin, have a way longer half life and thus the withdrawals last FOREVER.

This is all bullshit, it's called substitution, that's all it is. - I've been an addict for over 30 years.

Ibogaine is the only thing that's ever helped me and it still has not kept me sober.

I was appalled by this radiolab episode and feel obligated to share my experience. As a person in recovery and a MSW student focusing on substance use disorders and treatment, the information provided by the speakers in this episode was misleading. For one, the study indicating the success rate of AA is flawed. Using January first as a start date should trigger any critical listener's suspicions. January first is probably any moderate drinker's worst day or any problem drinker's chance to start a New Year's resolution to quit this year- with or without any real intention to do so. Another egregious flaw in this study is the use of one AA room over one year. A longitudinal study would have been more appropriate. I went to my first AA meeting five years before I was able to put one year of continuous sobriety together. Therefore if I had been a data point in this study, I would prove that AA really doesn't work. However, I can attest to the opposite. These are merely two issues with this study.

In regards to the use of medication for addiction treatment, your speaker Billy eloquently expresses why medication will not be the cure all of the future. Medication has its role in all psychological disorders. The Diagnostic and Statistical Manual considers substance use disorders to be bio-psycho-social disorders. We must address all of these areas to adequately address the health of someone who afflicted with such disorders. While Billy describes how his craving for alcohol subsides, his conception of self is unchanged and still broken. This is where AA and the 12 Steps do what medication can't.

Additionally, the use of medications cannot be viewed as a unilaterally safe alternative to other treatment. You mention gabapentin multiple times. It is used to treat seizers, however its off label uses are vast. This medication is abusable. Many doctors are unaware of this; I informed my psychiatrist of my gabapentin abuse and he expressed great surprise. I was prescribed gabapentin at treatment facility associated with Harvard Medical School and within moments of having the bottle in my hand, my roommate informed me that taking a small handful would render me pleasantly intoxicated. I carried this lesson with me to the very end of my addiction.

The misrepresentation of AA is my last concern. As others have stated our use of "God" is not in reference to a Judeo-Christian God. The first reference of "God" is "The Spirit of the Universe." If you ask me, this sounds much more aligned with Eastern traditions. Also, I know many people who are avowed atheists and excuse themselves from all prayer and are very happy members of AA. For myself, I decline to say the Lord's Prayer, but find great solace in reciting the serenity prayer. I've run out of space, but please contact me at the email address I provided. I love radiolab and sincerely hope that your demonizing portrait of AA will not keep anyone away from the program that may save his/her life.

There is a lot of flak towards RadioLab's comments on AA, and their omission of AA's phrase "Of your own understanding." I am an AA frequent with a decent chunk of sobriety under my belt. AA commonly uses "Of your own understanding" as a descriptor to your definition of God, but there is something -- and I say this as a member of AA -- frequently fails to understand, that many do not wish to have *any* God of *anyones* understanding. I am one of them. There's little room for an Atheist in Alcoholic's Anonymous, one who does not believe that turning our will to a power greater than ourselves (even if they are in our own image) is a possibility.

Your reporter so mischaracterized AA that I can't imagine anything else she said was accurate. The operative phrase in AA literature regarding God, which she didn't mention, is "as you understand him." In a great many cases, that means acknowledging "a power greater than yourself." As with lifting a heavy weight, that can simply mean two people. More than two is even better.

The book Alcoholics Anonymous, known as the Big Book because it is over 500 pages long, is not the "AA Bible." It is a book of suggestions, and clearly says so. AA has no bible, no leaders, makes no scientific claims.

I've been sober 24 years, thanks to AA. Most of my friends have double digit sobriety. Those that don't will. God (as I understand him) help listeners who came away like the one who wrote: "I had never really paid much attention to 12-step programs before I heard this podcast. I was blown away that they are just another pseudo-scientific bit of junk that remains prevalent in our society. I think most people assume that AA and other 12-step programs are based on science. They don't realize that they are literally the random musings of 2 very religious alcoholics from the turn of the century with no basis in any science." AA, just for starters, was founded in 1935, not the turn of any century I can think of.

This only just scratches the surface of an EXTREMELY important topic that I think everyone should learn about, even if they don't have an addict in their life. I just finished listening to the book 'Chasing the Scream' by Johann Hari, and I cannot recommend it enough. It's a revolutionary look into what addiction is really caused by: basically, what this episode of Radiolab was just beginning to scratch the surface on. A lack of connection, a lack of human interaction, which creates a gap that is then filled by addiction. Many, but not all, addicts had abusive pasts. A taster of that concept can be seen in this video, which I'm sure many people have probably seen, but which many more SHOULD see: https://www.youtube.com/watch?v=ao8L-0nSYzg

Decent podcast but it felt rushed. I could have done without the interview with the Dr over the phone, didn't really add anything and it was difficult to hear. I've been on Baclofen for over a year and know quite a bit about it but still wanted to hear more. All in all it's good they put this out there to spread the word.

One approach not addressed in this episode is hypnosis for alcohol addiction. Here is why I feel it is an important part of a treatment plan:

At the end of this show when they interviewed Billy I could clearly see how he could have benefited from hypnosis along with the other treatment methods. Mainly because he said, he didn't know how to identify himself as a man who didn't drink since most of his life changing events: meeting his girlfriend, forming a band, etc, all involved alcohol.

Hypnosis helps to break the false sense of success in life with alcohol association by helping a person to see it was his True Self or Inner Self that did those things, not the alcohol.

I know that people are either a fan of hypnosis or they are not, I am not trying to convert anyone. But as a hypnotist I know that unless you break counter productive associations or identifications that a permanent personal change is difficult.

And I have worked with many people and helped him to get to the source of their drinking problem so that the need to drink naturally transforms over time. Note: clients work with me under doctor or an LPC's supervision.

When I was finally diagnosed with ADD at the age of 45, the meds took away my urge for alcohol. I too, used it as a way to decrease my anxiety and to be in social situations, a way to clear my thoughts. I was never out of control, but I knew that "wishing I could keep alcohol at work" wasn't normal. I have many family members who are alcoholics and some have been treated for ADD, while some self-treat. I can also say that when you tend to be someone who is "hypersensitive", not just emotionally but sensitive to pain, sound, etc., I think it leaves you looking for a way to "calm" everything down to a level of normal. Thank you for exploring this topic. I love the show and the dedication you all give to your work.

Thank you for doing this show on chemical dependence. From all the comments it's obvious that this is still a very misunderstood illness as well as it's treatment. As a recovering addict and a board certified Addiction specialist ( MD ) I can say this ; while some of the comments may have been misleading, the very fact that we are talking about this as an illness instead of a moral failing is progress. This is a very complicated and multifaceted brain disorder and one fix does not work for each and every person. I will say that in the thousands of addicts that I've seen, the ones that get well are the ones that that work on the issues that made them want to drink/use in the first place - before they became addicted. Like the young man that said alcohol "was" him, it was always there, he was nothing without it. Perhaps this gentleman needs to delve deeply into why he needed alcohol to become himself in the first place. Using other medications as a " harm reduction " ( i.e. to prevent pancreatitis ) are fine for a while. However nobody is ever free until they rid themselves of the emotional monkeys on their backs.

Thank you again. Addiction is a brain disease. Sure it's a choice to use a substance early on but after a while in certain people a switch flips of sorts. That choice is no longer there and is taken over by that overwhelming craving that comes from the very base of our brains. The most primitive part of the brain that runs our instincts to survive- food, water and sex. In an addict drugs or alcohol will even trump all three of those. Yes, it's that powerful.

This episode was irresponsible and may dangerously misinform people suffering from alcohol addiction. Daniel from Australia and others share my frustration when storytellers ignore and fudge facts to construct narratives. As mentioned elsewhere in this thread, naltrexone and naloxone have been extensively studied and meta analyses have found modest albeit clinically useful effects for alcohol addiction. Clinicians, like the one shamelessly promoted in the podcast, have been using these treatments for years. Naloxone is omnipresent in healthcare settings because it is thee antidote for opiate overdose. Big pharma has ignored pharmacotherapy for addictions.. because.. because a TB cure made alcohol disorders.. uh.. the domain of AA. Radiolab - you're always entertaining but please don't allow that goal to undermine the safety of your listeners.

Just listening to "The Fix" and had to comment on my own experiences with taking the types of drugs that Dr. Mark Willenbring mentioned. I recently started taking Topomax to prevent migraines and noticed that I have zero desire to drink alcohol since being on the drug. This wasn't planned and is completely involuntary. When I look at a bottle of wine or liquor, I don't even give it a second thought, whereas before I would drink wine with dinner, and drink socially on the weekends regularly. When offered a drink at a party I don't even feel the slightest inclination to say yes. Not sure if this is a good thing, a bad thing, or just a thing. But there is definitely validity to the claim.

"The problem here is that you're trading an addiction for a lifelong reliance on a pill. Once the chemical addiction ends, there's the mental disorder that needs to be addressed."

I get the feeling you didn't actually listen to the episode. The medications that block the addictive substance don't need to be taken indefinitely. The people in these anecdotes took the medications for relatively brief periods of time. The medications prevent the addictive substance from reaching receptors in the brain, the person no longer gets a high from the substance, and eventually is no longer physically addicted.

Yes, of course it's important to address the initial reason that the addicted person turned to drugs in the first place. But don't you think that's much easier to do if their thoughts aren't being dominated by a physical dependency?

You say you work in addiction treatment. I wonder if the medications used in your field are the same as the type being discussed here. If you're thinking of something like methadone, which is used to wean people off of opiates (and I know plenty of people who are just as addicted to methadone as they were to pills/heroin/whatever), it sounds like the drugs discussed in this episode function differently. They remove the desire to take a drug at all.

Sure, there's no quick fix for any problem. But some fixes are quicker than others. Why not explore every option? If there's something out there that can solve the plague of addiction (and it really is like a plague, at least in the area where I live), it's at least worth a try.

The problem here is that you're trading an addiction for a lifelong reliance on a pill. Once the chemical addiction ends, there's the mental disorder that needs to be addressed. That is where 12-step programs (or other treatment) come in. As a person who works in the field of addiction, I see these poor kids who are totally reliant on pills and walk around in a fog and with the delusion that they are cured. I'm all for finding a medicinal cure, but the reality is that there isn't one. The money these doctors make off of prescribing pills to addicts for a life-long "cure" is uninformed, unethical, and irresponsible.

"People with addiction ironically are the fittest of the fit in evolutionary terms. They are the people who would have been earliest for the food, earliest for the sexual partner. On a genetic level they have the greatest sensitivity. They would be exquisitely in-tuned to the promise of rewards."

Something about this quote doesn't seem to make logical sense to me but I can't quite put my finger on it. I keep thinking how in evolutionary terms this would just lead to impulsive behavior such as eating a berry that is poisonous or putting ones self in unnecessarily dangerous situations that could lead to early death. I can see how those are positives in the right situations but I don't see how that's a long term adaptive behavior.

Or perhaps there is something else about the posited theory that's setting my antennae off. Does anyone else have a problem with that logic?

Thank you so much for bringing the science of addiction treatment to the attention of the public. I am a psychologist who works in addictions treatment and am proud to say I work for an agency that values offering Medication Assisted Treatments (MAT) to every eligible patient. I strongly believe this "sea change" is coming, as stigma for people with addictions is increasingly being confronted by health care professionals, politicians, and people with addictions themselves. The public are getting more and more critical of the U.S. War on Drugs which is crucial to reconceptualizing addiction from a moral problem to a complex biopsychosocial phenomenon. Unfortunately we have a long way to go in the field of addiction medicine as we don't yet have any FDA approved medications yet for the treatment of methamphetamine, cocaine, or marijuana (although doctors may prescribe certain medications "off label" for these addictions if there is research support for possible effectiveness). However, the more people learn about the FDA medications we do have for alcohol and opiates (heroin and painkillers), the more quickly we can create positive change in the lives of individuals with addiction and their families. Love the podcast. Keep it up!

I accidently happened into or onto this page discussing addiction and the use if certain medications to assist in treatment. I would like to comment strictly on the use of the drug naltrexone and the outcome it had in me. I had completed numerous rehabs, treatment, counseling, therapies, etc... name it-I tried it. However, during the last intensive program, I was offered the drug Vivotrol (injectable 30 day extended release dosage of naltrexone) and decided to try it. For the first time in 15 years, I finally felt that I could finally keep my head above water. I no longer obsessed and craved alcohol. The desire to drink was gone. For me, it was God sent. After the 30 days, it was obvious the injection was fading and that I would be back where I started if I didn't continue Naltrexone. That was the only hard part, finding a doctor where I lived that had even heard of it, or would risk the liability of prescribing it to me. After many exasperating attempt, I finally located a woman at a regional substance abuse center to help me and I due to insurance restraints was given a presciption for naltrexone in oral form. I am sober and personally attest to the power of this drug.

My name is Dr. Daniel Aronov and I just wanted to point out a few corrections from your recent podcast titled "fix"

Firstly, i wanted to say that I am a big fan of the show, I have listened to every episode.

In my practice I often use medication for alcohol addiction, however I thought that the portrayal of medications as a cure for alcoholism was a bit misleading

If you look at the evidece, there has been a large cochrane review of 32 trials involving 4700 patients with alcohol addiction.

The results showed that in the group given naltexone, 50.6% returned to HEAVY drinking versus 61.1% of people in the placebo group who returned to heavy drinking.

So while the drug definately works, it only works in about 11% of people over placebo. Interestingly, placebo seems to work in about 40% of people.

Interistengly, one of these 32 studies, (Krystal, et al., 2001) compared naltrexone versus placebo for treatment of severe alcohol dependance and while they found no benifit int he naltrexone over placebo, they re-analysed the data to find that patients who were more complient with the medication or the placebo were more likely to avoid relapse. This would lead one to believe that it's not the tablet that makes the difference but the will of the patient to change.

Similarly with regards to Acamprosate, 24 randomized control trials involving 6000 alcoholics has been meta-anylised by the Cochrane Collaboration in 2010. They showed that 75% of alcoholics who take acamprosate will return to any drinking versus 83% who return to any drinking on placebo. Again, about a 10% difference compared to placebo. Interestingly, there was no difference in return to HEAVY drinking in the acamprosate versus placebo.

Thank you for focusing on this interesting topic. I had a lot of questions at the end but found this episode fascinating. Please bring us more in the future on alcohol consumption, addiction and substance abuse.

So much was not reported, so much is missing from this story that I may stop listening to radiolab. Surely, the Canadian studies of the 50s regarding alcohol addiction were looked at, right? Amy O'Leary should contact me...I can't put all I want to say in a public comment box.

We know that addictions are not about the substance, eating disorders are not about the food, self mutilation is not about the pain, etc. all these things are coping skills. They give us something to do with the emotions we don't know how to deal with. They create a little relief from the pressures of a life that is altogether too confusing. Whether or not a person is using substances or acting on other coping skills, they're still addicts, seeking the 'high' of their own opiates that the brain releases. We become biological-opiate addicts! What started out as a means of helping us cope morphs into having a life of it's own.

Drugs mentioned in the podcast have been used to treat the symptoms of other mental-health illnesses.

A google search for "dissociation opiates" gives a result for a forum (link below) where self mutliation is treated with an opioid inhibitor.

http://www.dr-bob.org/tips/split/Naltrex-op-self-injurious.html

And another (link below) which states "Treatment with low-dose naltrexone may be a helpful element in the treatment of patients with complex posttraumatic stress disorder. However, it has to be realized that the decrease of dissociation may lead patients to a not yet resolvable challenge, in as much as dissociation had previously been a necessary mechanism of self-protection."

http://www.ncbi.nlm.nih.gov/pubmed/25421416

These kinds of drugs should never be used without the support of a therapist. They may help get rid of the symptom… but they're not getting rid of the underlying psychological problems.

From the episode: "People with addiction ironically are the fittest of the fit in evolutionary terms. They are the people who would have been earliest for the food, earliest for the sexual partner. On a genetic level they have the greatest sensitivity. They would be exquisitely in-tuned to the promise of rewards."

That quote in the episode seems like quite an assumption. I could equally point out that being too eager for short-term rewards is a problem, not an evolutionary advantage. Remember the marshmallow test - where kids who had better self-control had better outcomes in life, and kids who couldn't wait had worse outcome in life? I'd guess that kids with a high reward system would be the first ones to grab the marshmallow. In that case, the people with high rewards systems would: have been earliest for the food, earliest for the sexual partner, would grab the marshmallow first, would be most likely to be alcoholics. Honestly, that sounds like some less-successful people that I know: overweight, alcohol problems, had kids very early in life (usually on accident), trouble holding down a job, and with very little education. Chasing after short-term rewards can really screw up your life.

From this viewpoint, it seems like the alcoholics are not "the fittest of the fit in evolutionary terms". Quite the opposite.

Looking from a genetic point of view: "(...) Still, several recent studies have suggested that some people may be born with a defect in the gene that doles out dopamine receptors. Those born with the defect end up with fewer DR2s and as a consequence experience life with less intensity and joy, said Dr. Ernest P. Noble, a professor of psychiatry and biobehavioral sciences and the director of the Alcohol Research Center at the University of California at Los Angeles."These people often say they don't feel the normal rewards and pleasures in life," Dr. Noble said.(...)" [http://www.nytimes.com/learning/teachers/featured_articles/20001114tuesday.html]

Looking at the wiring of the brain: "(...) "People with addiction ironically are the fittest of the fit in evolutionary terms. They are the people who would have been earliest for the food, earliest for the sexual partner. On a genetic level they have the greatest sensitivity. They would be exquisitely in-tuned to the promise of rewards. (...)" [Source: The Radiolab Podcast "The Fix" after Minute 35:16]

My question: Is that a contradiction? If no, why? And if yes, how come?

Atheist, former heroin addict, clean for 11 years in a 12 step program. Statistics aren't reliable in these kinds of organizations who are anonymous by definition. I have more friends than I can count who have stopped using, lost the desire to use and found a new way to live. Many for 10+ years. This can work. Other things too maybe, but that's not my personal experience, using my own 5 senses. Find a meeting and see for yourself if you're looking for help. We're everywhere.

This seems like a superficial question atop the serious conversation going on below, but any chance someone could reveal who the music is in this episode?

Also, just wanted to throw in another chip for psychedelics to the conversation. I spend a lot of time in Peru and have seen a lot of people work with ayahuasca (DMT + MAOI). I've also seen people go off the deep end with it. Thus, I think for addiction a controlled environment is key. I've heard great things about this place in Tarapoto that started because of the high level of cocaine addiction in the area.

Diana from Texas hasn't lived my life. Suboxone (Buprenorphine/Naloxone), whether used for detox or long-term maintenance works. There isn't a one size fits all "cure" for addiction. I spent a year of my life in in-patient treatment combined with going old fashioned cold turkey for opiates. That lasted 16 months.

I have been on Buprenorphine maintenance for the past 8 years. It's working for me and countless others.

Naltrexone used with The Sinclair Method is just as effective with or without therapy. It is to be taken out and used only when you drink and you do take it if you ever drink on those occasions for the rest of your life if you still want the benefits of it.

AA condones only abstaining, so if taking Naltrexone with the Sinclair Method, would would be highly opposed to this medication because you have to drink for it to work in the brain.

This is not my opinion, it is laid out in The Sinclair Method. http://www.sinclairmethod.com/index_files/Page399.htm You can read it yourself here is the link.

This is not just my opinion. The scientific studies and the Doctors instructions are at that link.

Please read the information and find out what it says. Some are making statements that it is not true which will only keep people from this wonderful help.

The podcast didn't even mention the work of Dr. Sinclair whose revolutionary work is essentially clinically proven. Anyone who chimes in that the science isn't there or there is not enough data and so on needs to catch up on his work. The work is there for you to review including double blind clinical trials with results up to 80% success. The Sinclair Method (TSM) is not a treatment that uses a drug to reduce cravings per se. It uses Naltrexone to cause pharmacological extinction much like process that Pavlov used with his dogs a hundred years ago. Furthermore his studies indicate that TSM is just as successful with or without therapy. The science is simple and the process works.

The podcast does mention that the FDA had approved the drug a long time ago 1994 iirc but the problem is that they did not approve it in accordance to TSM. So in many cases alcoholics were prescribed Naltrexone just as a daily dosage and also to remain abstinent. Well Sinclair, being a smart guy, designed a study around that which actually showed that those who take Naltrexone daily and remain abstinent actually get worse. And my guess is that those cases end up back in traditional faith based abstinent type programs and they chalk that up to yet another failed attempt at a medical cure, they are wrong. In order for extinction to occur you have to provide a stimulus without a reward, the dogs hear a bell but get no food.

I know it works not only from reading the studies behind it but from my own personal experience. I was a very fast responder with TSM and went from 15 drinks a day for the last 20 years down to an average of 3 within 3 days. Drinking on Naltrexone still gives you a buzz so there are some important misleading ideas presented here. I do believe that as an alcoholic you do gave to actually want to stop drinking in order for any treatment to work but then I bet the far majority of us who wake up sick every morning promising ourselves to not drink the following night only to find that we stop off at the liquor store and proceed to get wasted and start all over again actually DO want to stop.

What TSM does is cut off the insane chase that an alcoholic gets after having the very first drink. This chase is a learned behavior that was reinforced with every drink we had since the very first day we drank. With TSM you reverse that and do not provide the reinforcement when you drink. That is not to say you don't still get buzzed or even enjoy the drink. There are other parts of the brain that are rewarded with alcohol but it's the opoidergic part that we have issues with. Naltrexone takes that out of the equation.

All I can say to anyone reading this is what have you got to lose? Naltrexone is cheap and is very safe.

You led to a question that you did not answer at the end of the episode which maybe some of the doctors contributing comments could address:If it is the same brain chemistry reaction that is involved in love and addiction, will taking these pills have you fall out of love?

Hey, I want to start to by I love the show and glad you are shedding some light on the topic. Some very good questions being asked.

I am a therapist that has worked with mental health for the last 10 years and in addiction for the last 4 years. I am concerned that the view is that treatment is either medication or self help. But in my experience there is more of a combination approach. I agree that there is no quick fix but medications can help initially. Also Naltrexone and those medications have been used for quite some time and is not new. There are studies out there that the most success for people is when they have a combination of treatment such as medications, therapy, self help and friends/family. Most of my treatment has been out of Worcester MA which has a huge addiction problem but also has a lot of good treatment available. I am wondering why there wasn't a therapist's perspective included in this story?

Has your show thought about breaking down the stigma of therapy? Importance of treatment?

Dr. Puck Loptr, Official Internet Expert
from In an elliptical orbit, between Earth and Mars

This was a fantastic podcast. I had never really paid much attention to 12-step programs before I heard this podcast. I was blown away that they are just another pseudo-scientific bit of junk that remains prevalent in our society. I think most people assume that AA and other 12-step programs are based on science. They don't realize that they are literally the random musings of 2 very religious alcoholics from the turn of the century with no basis in any science.

Radiolab should do a story on all of the pseudo-science that pervades American society. Just think about your average Alcoholics Anonymous attendant.

They wake up, brush their teeth and use their mouthwash(fake science!). Then they go off to their chiropractor(fake science!) appointment because their back hurts. They would rather do this then have back surgery(bad science!). They have a bit of a cough, so they get some zinc lozenges(fake science!) and some vitamin C(fake science!). Then they go to their AA meeting(fake science) and do group therapy(bad science?) while completely abstaining from alcohol(bad science?).

Call it the Karl Popper episode? It might be interesting, since Karl was a huge proponent of empirical evidence. He also had his own issues.

I recently decided to ask my doctor about Naltrexone. I have two years clean from alcohol and tobacco, but I still struggle with cravings. And while I have stopped those two drugs, I still have a life full of disfunction and pain around food and technology (Internet, TV, Phone etc.)

I'm wondering if the same systems have simply found a different target. I go to 3-7 meetings a week, I work my steps, I make calls... But I can' only slightly and temporarily make changes from one day to the next in these areas.

I noticed that the last person on the show stopped going to meetings, and did not mention therapy. My plan. Intention, hope is to combine these to possibly make a difference.

I thought of this idea after looking back on my smoking & drinking and realizing that they shot through the roof after i stopped taking Wellbutrin.

Because of the HIV outbreak in Indiana, we (in the substance abuse treatment and public health industries) are taking a new look at drugs like Naltexone. I had never heard of it until last year.

Maybe the doctor will suggest antidepressants, maybe Naltexone. I don't care. I want off this ride.

Naltrexone may very well be helpful, but it is to be used in conjunction with therapy and/or support. It isn't' meant to be something you take out once in a while when you want to drink (I.e. Gab Glaser's) or tht you take for the rest of your life, per a poster above.

AA isn't opposed to this, either. Nothing in the literature would suggest that. If you are hearing something else, that is a person's opinion and should be viewed as such.

Iti. Also important to remember that this pill doesn't make you less drunk (BAC). You simply feel less of an effect.

You have been had; drug companies are subtly trying to influence the public perception of addiction to get people to believe that they have the answer. 'Maintenance medication' is now required to be allowed in drug courts because President Obama has been had as well. Giving opiates to opiate addicts keeps them addicted and drug companies profit both ways - selling expensive Suboxone for 'maintenance,' selling hydrocodone/oxycodone when maintenance fails and then Suboxone again when caught. Naltrexone blocks opiate receptors in the brain; which includes blocking endorphins. No one stays on naltrexone long-term because there is no joy in an endorphin-blocked brain. AA is free. Available to everyone. Addresses underlying reasons for addiction. Living happy, joyous and free for 11 years and counting.

Would Alcoholism exist if the societal pressures and expectations were different?

It's frustrating and boring that in this universe, our society settles / defaults to socializing with alcohol or substances as a centerpiece. To me this is the bigger conundrum. Some people can manage their addictions, but to those who can't, our culture isn't really setup for many alternatives.

Naltrexone does work for excessive drinking and alcoholism. It works in the brain to eradicate the habit. It's modern day science. The AA Big Book says, someday there might be a cure, and this is it. Why do people have such a problem believing this? It's related to not believing in the polio vaccine. Contempt before investigation I believe.

A lot of comments here against Naltrexone are wrong. You don't have to take a pill everyday for the rest of your life. You take it only if you are going to drink. It's a very safe drug with hardly any side effects.

You don't get the high from the alcohol so you learn to deal with life on life terms. You can go to therapy instead of having an AA sponsor. Most of the behaviors AA says are only in alcoholics are really in a lot of normal people also. They are not reserved only for alcoholics.

People hearing this for the first time, please try this method. Do not listen to the people against it because they do not know the truth about this method of treatment, the Sinclair Method. 80% success rate, 3% for AA stated in their own literature.

I left AA after 28 years, feeling abused an used and blamed for my relapses ready to kill myself, and none of them cared. I used my too smart brain, as told by them, and researched scientific methods used for alcoholism and found the Sinclair Method and it has been a wonderful relief. If I had stayed in AA I would have finally died and it telling me to stay there so they could prove their point at my expense. And you will see the perfect comments coming to me saying these things from the pro AA people. Blaming me for not working the program right, again blaming me, even though I am one of the 97% it doesn't work for. You will see the blame in their comments proving my statement of that happening. It unfortunate AA doesn’t change their program to work for more people, but part of the rhetoric of the program is you can’t change it, like the Bible.

If you are court mandated to AA, it is against your constitutional rights and it can be fought. You will be forced to attend religious meetings which are safeguarded in the Constitution.

Do not go to AA. There are at least 9 other things that work better than AA. Do not listen to the people that try to persuade you to go. It is a religious cult and that is what cults do to hook you in. If you want religion go to a church of your choice. I'm telling you to stay in the modern day 21st century. Not to get into a program that has not changed in over 40 years that is in the dark ages .

If private drug companies don't want to do the product development for drug addiction vaccines in this country, he market his intellectual property in other nations of the world. That is how the hybrid car technology came on the market - the big 3 automakers in US weren't interested in building cars that would cut into the market of their profitable gas-guzzlers with far less profitable technology. So Amory Lovins took his concepts to the Japanese automakers, and they went for the deal he offered them.

So you stop drinking, but you take pills for the rest of your life. Are there long terms studies on the effects of Naltrexone/Baclofen? I think it's irresponsible to promote miracle cures without knowing all of the facts.

I have the disease of Alcoholism. I would very much urge anyone listening to this to realize that there is not a wonder drug that will cure this disease. It may help initially, but I would highly recommend a 12 Step program in conjunction with any drug or therapy one might receive. Alcohol is really just a symptom of a much larger problem. The cravings might be removed but you still need to learn how to live life on life's terms. I live a happy, well adjusted life today but it is because I put work into it and didn't rely on another "pill" to fix my problems.

It would be wonderful to hear the unedited interviews by the two scientists, especially in regards to their views on heterogeneity among people with addiction. This might help clear up the either/or debate (medical issue vs spiritual malady) that exists primarily in the media, impressed upon society. Addiction researchers know the disorder is nuanced, and each individual brings with him/her different sets of issues. One person might benefit completely from naltrexone or AA, while another needs a combination of the two. An entirely different person might need mental health treatment for anxiety or depression, while another needs something else. The key is understanding the variability between people and what will be most effective to treat each case. There is no magic bullet (e.g., baclofen, naltrexone) or blanket treatment (e.g., AA), but our understanding of what drives addiction has jumped light years in the past 3 decades. By providing better education to the public and to the medical doctors (yes, there is a severe lack of good addiction education in medical schools), we can treat this problem effectively by working together, using the knowledge and experience we have gained.

There's an interesting protocol that has been used for opiate addiction than fits well with the conclusion of this piece. There's a substance called iboga, a hallucinogen which tends to be not much fun and very thought-provoking, similar in this respect to peyote. It is used by the Bwiti people as a religious practice, for a spiritual journey. As a side effect, it blocks opiate withdrawal symptoms, and makes opiates have no effect for about a month. This because known when an opiate addict happened to try the religious practice, he ended up quitting opiates, because they stopped working afterwards. On the other hand, people have tried using noribogane (a chemical related to the main active ingredient in iboga), which has the same main effects, but it hasn't been as effective. There is a conjecture that, along with taking a month off of opiates, the traditional iboga practice is a good way of soul-searching and coming up with what to do with your life when you're sober.

Hi, I have been on a doctor-monitored program using Topiramate to stop my sugar cravings (along with seeing a nutritionist, a life-coach, and an exercise coach). I have lost 40 pounds so far- when countless other programs have failed. For the first time in 48 years I don't feel ruled by a constant obsession with food. This is a true miracle for me, so these drugs can help with addictions beyond alcohol.

The future in addiction treatment will rely on evidenced based methods. Medication, therapy, mindfulness meditation, relapse prevention and other wrap around services. Meanwhile AA will continue to be available as a voluntary resource in the community. Right now I am enrolled in a ground breaking treatment program on an IOP basis. Clients are receiving opiate replacement medications while attending mandatory weekly groups and therapy. Most programs that offer Buprenorphinre treatment dish out a 30 day script and quick appointment with the psychologist. The majority really do not actually have weekly mandatory groups, vitals UA's, pill counts and therapy. MAT is not meant to be a stand alone option for addiction. I believe this type of Suboxone program will replace the pill mill type setups they have spread throughout the South. Combining weekly groups and therapy along with medications as far as I am concerned is one of the most successful forms of treatment for opiate addiction. I am now tapered down to 2 milligrams of Sub and will likely be completely off the med In a month. Each week I attend a voluntary AA meeting and a mandatory group on mindfulness. Vitals are taken and each client receives a weekly UA. Those abusing the program are quickly weeded out.

I am SO DISAPPOINTED in this episode. Not enough research was done into this. If you going to do an article about this, talk to alcoholics!!!!!! They would tell you the drop out rate for AA is high because people relapse and come back. I am part of a group of young people that got off heroin before they were 23 becuase of the program. Many of us have kids and good jobs not because of it and the spirituality gave us the will to live and do better not a pill that took aaway the craving. Addiction has very little to do with craving at the end of the day its why you got addicted in the first place. This American Life also did a disapointing episode and I no long want to listen to either. I am hurt by this why would you do unresearched pieces on a program that save millions of lives?? You will deter people from the one thing that can truly help them. I was on naltrexone, suboxone and the other medications and they take away the craving and not fix the problem. It is HIGHLY likely to go back unless the underlying problem is fixed. If you did you research, the steps say God but they ACTUALLY mean a power greater which is highly impressed upon member that can mean anything, a tree a doorknob. Its not about God. Pills don't fix pill problems. Maybe then can help but not on their own. I didn't like this episode. And I will discountine listening.

Yes, PLEASE do a follow-up show. Alcoholism is a family disease. Yes, it's wonderful that a pill can get people stop drinking. But then, they still have the character defects of an alcoholic. The are still alcoholics. I know some disagree, but this is the theory of 12 Step programs, and I find it true from years of experience. A LOT of alcoholics /drug addicts, after getting sober, also attend Al-Anon meetings. Because it's about healing, living in the world, getting along with other people, loving your family.

Anton, I think you might enjoy listening to another story that we did a few years that looks at psychedelic drug experiments - both past and present. It's called "Blisshrooms" and is the the final story in an episode called "Bliss". You can find it in our archives here on the website. För Sverige! Thanks for listening.

Much discussion seemed to suggest anti-craving medications as stand-alone treatment, but this turned around in the later part. Naltrexone, baclofen and others are probably essential for many seeking addiction recovery. But similar to anti-depressants for major depression, medication can alleviate the immediately distressing and life-impairing symptoms, but cannot address the psychosocial issues that were antecedent to, or a consequence of, the depression or addiction. In the addiction treatment field, the 12-step adherents and the biomedical professionals typically dismiss the other side. In both camps, dogmatism and rigidity get in the way of understanding that many patients optimally benefit from both approaches. After listening to this show, I was really pleased this was the take-home message.

Also, the figures on AA success (early in the show) were erroneous, likely from flawed study design. But, AA does have a high rate of early dropout due, in part, to the alienating religious-appearing language. To lessen dropout rates, researchers have developed AA education modules, delivered in the first weeks of residential or outpatient treatment. Long-term follow-ups show higher abstinence rates in patients randomized to treatment+AA ed vs treatment alone.

Last, I want to thank the dedicated professionals, especially my past (and hopefully future) boss Mark Willenbring; and thank those who shared their stories. Billy, I’m glad you’re now on stable ground, and that it’s here in STP.

Really interesting subject. If this was an episode about a particular drug, I can accept the content in full. However, If this is an episode about getting rid of addiction, I find it quite strange that substances outside or on the fringe of pharmacology aren't even mentioned. Take the studies on LSD, psilocybin or Ibogaine in therapeutic use for example(for addiction that is), and the incredible results recent studies seem to indicate. I get that there is a stigma around these substances, as well as false propaganda and a lot of ignorance, and I'm not even sure how known these treatments are. If there's a follow-up on this episode, Im really hoping that you can shine a light on this as well.

An amazing program, especially in light of the discussion of addiction as a disease at the Democratic presidential debate. When you arrived at Billy's reluctance to take the medication because his identity was so intertwined with his alcoholism, I was reminded of how some depressed, paranoid, and schizophrenic patients refuse medication because they cannot imagine life without the obsessions and illusions that have become so much a part of their reality.

Important topic; thank you. However, my understanding is that the scientific evidence of most mental illness shows that drugs work best with therapy and vice versa. My experience has been that this is the case, both in observing patients and in talking to medical professionals, treatment centers, AA folks, etc. Hence, it is NOT an either/or question as you presented it in most of your podcast, which was disappointingly misleading. Your premise--we have a drug for depression so people don't need therapy--seems silly. Perhaps my impressionistic evidence is wrong. Most people on anti-depressants do very well without therapy?

This entire episode reminds me of Herge's Tin Tin, specifically Destination Moon, where before the crew launch to the moon, Calculus slips Captain Haddock (who is known to be a drunk, a pill which makes Captain Haddock's whiskey taste absolutely horrible.

I really think an entirely new perspective could be explored via the work of Dr. Gabor Mate and Dr. Bruce Alexander among others.... Their work explores the issues beyond what can be seen as the (Sometimes) false dichotomy popular in American culture - the one presented in this show - between medical treatment and spiritual treatment..... I think you could do a wonderful show with the ideas explored by these doctors - specifically thinking about the book by Alexander called "The Globalization of Addiction" and a book by Mate called "In the Realm of Hungry Ghosts".

Very appropriate show for me. As a lifelong alcoholic I've tried several of the meds discussed. Baclofen worked to help me quit drinking but the side effects were unbearable for me: complete space brain, I couldn't hold a thought in my head to save my life.Naltrexone works, but only if you use it to extinguish the drinking behavior. To do so, only take naltrexone prior to drinking. For me initially this was every day, but since my cravings have diminished it became only two or three times a week. Always take it at least an hour before inbibing. This regimen has made me "normal." I still enjoy the taste of a good beer but am disinterested in drinking more than one or two. I definitely understand Billy's point regarding the difficulty of living with sobriety, especially being part of a family that tends to relate via alcohol. Another drawback is that taking it seems to extinguish other behaviors as well (e.g. A healthy addiction to exercise) so I try to keep from drinking so that I don't have to take the pill and screw up other behaviors. So, in conclusion, there is a magic pill. But you have to be willing to take it an hour before any drinking for the rest of your life.

Best Radiolab show in a while but I would have liked the show to go even further in its investigations of the addiction treatment dichotomy.Felt it only skimmed the surface;s if it was shying away from a few questions.But great show all the same..Real discussion starter Maybe a follow-up show?

I take Naltrexone for drinking, and I was on a 4 month study and was getting a once a month injection of the medication which is trying to be approved for in canada; right now only the once a day pill form is available. After the study ended I went off the drug for 2 months to see if anything changed and I did, my cravings for booze went back to what it was previousl. So I started to take the pill form and it reduced again, I am still taking then pill. It does work, it reduces my cravings for alcohol immensely and it also changed my habits of being able to go out and party and not drink. It's worth trying.

Someone I know found his own cure for his alcoholism after heavily researching the biochemistry of what happens, etc. He found that alcoholics almost all have a problem metabolizing B vitamins which regulate nervous system function among other things (further illuminating the connection to muscle relaxants as effective).

He began self-treating with therapeutic doses of high quality B complex vitamins and a few other things like zinc to support uptake and it worked for him.

He concluded that because the nervous system suffered from lack of B's, alcohol radically smoothed the nervous system, allowing them to 'function'. Unfortunately, intoxication and euphoria are imbalanced with alcohol because it distorts blood sugar, and for a host of other reasons it is a very ineffectual 'medicine' as we all know but it's easy to see the connection between how alcohol relaxes muscles and therefore nerve pain, and B vitamins and the nervous system.

I usually enjoy your show, but this one was disappointing to say the least. In the first of the half of the show you insinuate that chemical magical bullets are out there, but doctors don't know about them or refuse to prescribe them. So, so false. As a Psychiatrist with 40 years of experience, I have been prescribing these medications for over 20 years. They have been common knowledge in the Psychiatric profession for all that time. AND, they work maybe 10 percent of the time. It is only when you got to Billy's story, that a bit of reality set in.Then you compared it to Prozac being the magic bullet in Depression and even that you got wrong. The only advantage that Prozac has over the earlier tricyclic antidepressants is a better side effect profile. In some cases the older antidepressants have BETTER effect than Prozac. And Prozac (and all the newer ones since) are not free of side effects, and neither are they always successful.I heard you speak in Salt Lake City, and you said your goal was "sticky science." Well this episode was really lacking in the science department!

This is an amazing story. I showed it to my husband, a family physician in Western Maryland, where it's incredibly difficult to get people into rehab due to there not being many choices! This is especially true for people on Medicaid. He will probably start trying the baclofen on some of his patients, if only for the low cost of the pills!

Thank you for this show. My mother is an alcoholic. I have so many feelings in listening to this, but the overwhelming thing I have learned from my mom and her struggle is that alcoholism is a disease. For those of us without this disease it is difficult to understand. I do wish the stigma surrounding alcoholism and addiction could be erased, because it makes people who suffer feel shame, which makes it that much harder to ask for help. I just want to offer courage and strength to anyone struggling.